Organization Active NPI

Eastside Orthotics and Prosthetics, Inc.

  • Prosthetic/Orthotic Supplier
  • New York, NY
National Provider Identifier
1982608493
Registry record updated Sep 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
EASTSIDE ORTHOTICS AND PROSTHETICS, INC.
Practice address
622 W 168TH St
Vc333
New York, NY 10032
Phone
(212) 305-3275
Fax
(212) 305-5927
NPI assigned
Jun 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Matthew D Flynn, CP
Title
President
Phone
(631) 727-8735

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

622 W 168TH St
Vc333
New York, NY 10032

Mailing address

34 Commerce Dr
Suite 200
Riverhead, NY 11901-3174
Phone (631) 727-8735

Other identifiers 1

IdentifierTypeStateIssuer
01052611MedicaidNY

National Provider Directory

National Provider Directory

Locations

622 W 168th St
#333
New York, NY 10032
Phone (212) 305-3275

622 W 168th St
Rm 333
New York, NY 10032
Phone (212) 305-3275

889 Harrison Ave
Ste 2A
Riverhead, NY 11901
Phone (631) 727-8735

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190160000000",
    "number": "1982608493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 COMMERCE DR",
            "address_2": "SUITE 200",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119013174",
            "telephone_number": "631-727-8735",
            "fax_number": "631-727-6834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "address_2": "VC333",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10032",
            "telephone_number": "212-305-3275",
            "fax_number": "212-305-5927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE ORTHOTICS AND PROSTHETICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2007-09-19",
        "status": "A",
        "authorized_official_last_name": "FLYNN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-727-8735",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CP"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01052611",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.